Response to interpellation 2024/25:556 on measures against the presence of criminal actors in the welfare system

Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Lars Isacsson has asked me whether I consider it sufficient that the Health and Social Services Inspectorate can only intervene when there is a danger to life and health, even in cases where economic crime occurs, and whether I intend to take the initiative to tighten the regulatory framework so that criminals cannot run health centers and other welfare activities.

The government obviously takes very seriously that criminal and unscrupulous actors are running health centers and other welfare activities. When unscrupulous and criminal actors enter the health and medical care sector, it does not only affect society economically but also leads to deficient and patient-unsafe care.

To counter unserious and criminal actors within Ivo's area of operation, the government has decided on several assignments and regulatory changes and allocated extra funds to the agency. Among other things, the provisions in the ordinance (2013:176) with instructions for the Health and Social Care Inspectorate have been changed so that it is now part of the agency's assignment to prevent and counter crime within its area of operation.

In accordance with the provisions of the Patient Safety Act (2010:659), Ivo exercises supervision over healthcare. The supervision involves reviewing that the operations meet the requirements and goals according to laws and other regulations. The supervision shall primarily be focused on reviewing that the healthcare provider fulfills its obligations to conduct systematic patient safety work.

Within the framework of its supervision, Ivo shall, among other things, provide advice and guidance and ensure that deficiencies and irregularities are remedied. Ivo also has an obligation to provide information to other authorities according to the Act (2016:774) on the obligation to provide information in cooperation against certain organized crime in order to prevent, hinder, or detect criminal activities that are of a serious or extensive nature and are conducted in an organized form or systematically by a group of individuals.

Ivo has an important role when it comes to preventing and countering unserious and criminal actors within the health and medical care, but the regions must also take their responsibility when municipal matters are handed over to private actors.

A region is, according to the provisions in the Local Government Act (2017:725), obliged to monitor and follow up on activities that have been handed over to a private operator through an agreement. This implies an obligation not only to ensure an opportunity to follow up but also to take active measures to follow up the activity. This means that the region can, if necessary, terminate such an agreement. Furthermore, the region shall, through the agreement, ensure information that makes it possible to provide the public with insight into the activity that is handed over.

That unserious and criminal actors exploit the compensation system to finance criminal activities is, of course, completely unacceptable. It is therefore important that Ivo and the regions use the tools they have so that unserious and criminal actors do not run health centers. I fully share the view that crime against health and care must be taken most seriously. Against that very background, I have, together with the government, decided on several measures in the work against welfare crime within health care and care. We continue to work actively with the issue.

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Lars Isacsson (S)

Madam Speaker! Thank you to Minister Acko Ankarberg Johansson for the answer!

The background to my interpellation was Ekots' audit, which showed that several health centers in Gothenburg, where serious financial irregularities such as tax crimes and money laundering had occurred, could have continued their operations with public funding despite the crimes being so extensive that they had been noticed by both the Swedish Tax Agency and law enforcement authorities. But because Ivo, the Health and Social Care Inspectorate, according to current legislation only may intervene if there is a direct danger to life and health, these actors have been able to continue as if nothing had happened.

My question to the Minister was simple but important: Is it really reasonable that Ivo cannot act against a healthcare provider in cases of serious economic crime without it first having to be a risk to the patient's life? I also asked whether the government is prepared to change the law so that criminals cannot run health centers and other welfare activities.

Madam Speaker! I thank you for the answer but had hoped for more, if I am to be honest. We were told that the government takes the problem seriously. That is good. We were told that Ivo has received a mandate to counter crime and that certain regulatory changes have been made. But what we were not told was when the government intends to proceed with legislative changes that actually give the authority real tools.

What I and many others see is that the criminal methods have evolved, but the legislation has not kept up. The result has been that serious criminals can use the welfare system as a cash box without risking consequences. We must draw a common line against organized crime in the welfare system as well, and that line is missing today.

Madam Speaker! My question remains: When does the government intend to take the initiative for a legislative change that ensures that serious economic crime can lead to a business being shut down without it being required that there is a danger to life?

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you, Member, and I thank the Member above all for posing the question and that we are given the opportunity to exchange thoughts and opinions.

Let me first say this: It is not permitted to conduct business if one is a criminal. If it is done, there has been a failure in several positions, primarily in regions that enter into agreements. I intend to speak about why regions must become better at following the law.

The second thing I want to bring up is what we can do so that both the regions and Ivo can get more tools to be able to do their jobs.

I will start with what concerns the mandate one already has. I share what I perceive as the member's irritation and anger that tax money is being used directly for criminal activity. But it is clearly stated in Chapter 10, Sections 7, 8 and 9, what a region or municipality must check before they conclude agreements.

When one operates a health center, the region must first decide which requirements apply. It is not possible to just rush in, start, and get paid. There is no right of free establishment in that respect. One must fulfill the requirements that the region sets. But in this case, it is obvious that the region has not set requirements or followed up on what is necessary. Only after the police and Ivo had carried out the raid did Västra Götalandsregionen come to the mentioned health center and say that they were withdrawing the contract. Of course, this should have happened earlier. Before one enters into a contract, one should secure everything one can and then follow up – not just in general, but very actively. This is stated in the law, including the preparatory works.

I am glad that both the Stockholm region and the Västra Götaland region started this work a couple of years ago anyway. It can therefore be seen as surprising that the Västra Götaland region did not discover this. I view their work to better be able to identify those who are unserious and those who are criminal very positively.

When doing this, one must be clear about the requirements being set. For example, requirements must be set on the readiness of private contractors. They have the same readiness responsibility as public contractors, shall receive doctors and nurses during training, and much more.

The regions are to first determine which requirements shall be set for the contractor and then follow up on the whole thing. This has obviously not happened at all in this case. It was only after the police and Ivo had carried out their raids that the permit was revoked.

Let me nevertheless return to the fact that Västra Götalandsregionen has ambitions. I want to say that to the member. They have established an office and are carrying out work. That makes me even more concerned.

When both they and Stockholm, who are still trying and have done so for a couple of years, do not succeed, it shows how advanced this crime is. I am absolutely certain that Västra Götalandsregionen would not in any way have wanted to have these who are criminals. But still, they have slipped through the net.

It shows that we must look at this in a completely different way. These are not the ones we have encountered before within healthcare – someone who salts invoices or the like. So, of course, one should not do that, because it is wrong. But we have had methods to find that sort. That is where we are. Now, people are coming in who have not at all intended to provide healthcare but only want to exploit our system to get money for other criminal activities.

We must change both the perspective and the competence in regions, Ivo and other authorities to understand it. It irritates me that we will have to hire people to get functions for it. I would have preferred to be them beforehand. That is why I return to the regions. The region must first, when it determines requirements and concludes agreements, make it as difficult as possible for a contractor to conclude an agreement. Because if they have already come in and concluded an agreement with the region, we have to do everything in retrospect all the time.

I really want to encourage all regions, and municipalities in cases where it is relevant, to look closely at what requirements they set and ensure that they follow up on these.

Let me return to what tools we need to give both Ivo and the regions for this to work.

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Lars Isacsson (S)

Madam Speaker! I appreciate the opportunity to discuss these issues, and I look forward to hearing about the tools that the Minister will return to.

Overall, there is a lot of focus on regions and municipalities regarding what responsibility they have. They obviously have a great responsibility. But we in the Riksdag also have a great responsibility to give them the right opportunities, and the government perhaps has an even greater responsibility than the Riksdag. We from the Social Democrats stand ready to help provide them with these opportunities.

It is good that the Minister brings up what the situation looks like out in the municipalities. I come from Dalarna. There, we have several examples of children who have been placed in HVB homes without the municipalities having insight into who actually stands behind the operations. There are unclear ownership structures, financial irregularities, and in some cases, links to criminal networks.

I know that the Minister is aware of how it works out in the municipalities. It is social workers who submit cases to the social committee or the individual committee, and it becomes one of the hardest decisions one as a municipal politician can make. Through the Act on Care of Young People, parental responsibility is taken away from parents and the child is placed in an HVB home.

At the same time, the police know that there are 26 HVB homes run by criminals, but they are not allowed to say it.

It also becomes a cost. It creates a huge pressure on a social welfare committee when a municipal executive board chairman comes and says that the budget is not being kept and that a place at an HVB home costs 8,000–10,000 kronor per day.

I do not think the municipality has the right opportunities to make such decisions and take the responsibility that the Minister says one has. The responsibility cannot simply be pushed downwards if the tools are missing. We cannot leave social services, municipalities and regions alone to handle organized crime in the welfare system. I know that they are not actually alone, but I believe they feel that they need more support.

This is a structural issue. It is not just about individual deficiencies in the control, but in my opinion, there is a legislative loophole. It affects the most vulnerable. Therefore, I would like, Madam Speaker, to pose a follow-up question to the Minister. Is the government prepared to introduce a clear legal requirement for transparency regarding ownership for those who provide welfare services so that it can serve as a basis for denying or revoking permits? I look forward to the Minister's next contribution when she is now to explain which measures will be taken.

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! Thank you, the member, for the supplementary parts!

Let me take up the last point that the member raised. This is already in the Local Government Act, which the member and the Riksdag have decided on. Use the paragraph! It has actually never been used legally, which means we have no case law. We therefore do not know if it is sufficient.

I do not really like to add a new law when we already have one just because we think it is not working. Use the laws we have and test them legally!

I believe that the Local Government Act goes far enough here. It states exactly that the public shall have the level of transparency required in the company that one enters into an agreement with. I have urged municipalities and regions, when I have met their organization SKR, to use the paragraph in the Local Government Act that the Riksdag has decided on. The Riksdag has decided that this is important, and then we shall follow it. It has not happened yet, but I constantly encourage them to use the possibility of transparency and control, because it exists in the Local Government Act.

In the same way as when one conducts activities in one's own name, I think it is obvious that if one entrusts a matter to others, one should be able to monitor them to obtain full insight. The Local Government Act gives the municipalities such opportunities.

But what about the tools? It is true that Ivo, even before the pandemic, made a list of 40 measures that, according to their assessment, in different ways needed a change in regulation and legislation in order to be able to function. The previous government managed one and a half measures. I am aware that the pandemic came in between, but quite little was done.

We have, of course, continued with the list. One of the investigations concerning Ivo is presented on April 15 and concerns which additional legislative proposals are necessary. The Riksdag has decided on the procedure that cases are processed through investigations. One does not rush forward with a legislative proposal after a week; instead, we conduct investigations. One of them will arrive next week, as mentioned, and many more will come further ahead.

Let me raise a point that is just as urgent as the regions taking their responsibility from the start. It is that we provide tools. We must work with confidentiality-breaking provisions for municipalities and regions, so that they can take on more tasks. But here there is a balance to take into account. How much should they be allowed to take on? The regions are large in relation to a regular municipality. Regions can employ staff who have a bit more competence. But the regular municipality has 12,000–15,000 inhabitants. How are they going to be able to manage this? This is a challenge, and we need to consider how cooperation between primary municipalities can occur so that they have access to the competence that is required.

It must be said that there is a difference between health centers and HVB (residential homes for people with disabilities). Since health centers are governed by a law, we must have decided on the requirements in advance, not first when one procures. First, the municipal council must have decided on which requirements to set in the choice of care so that there is full democratic oversight within primary care. There, the requirements need to be sharpened.

Municipalities and regions, however, need more confidentiality-breaking provisions so that they can access data in different ways. It must still occur in a secure manner so that we do not send data into the wrong hands. The authority Ivo also needs more tools. We are currently working on this both through state inquiries and through changes in instructions.

Ivo has now finally become a so-called LUS agency, which means that they are an agency that receives a share of tasks related to advanced crime. That was why they could be present at the raid mentioned in the interpellation. At that time, the police and Ivo were present at the raid simultaneously, precisely because Ivo had the opportunity to do so.

The police cannot contact a municipality or region just however they please. It must occur in an organized manner. That is why we have a law that governs this, the law on special submission of information or retrieval of information. I regret, Madam Speaker, that I cannot recall the name of that specific law. It is very good. They are also an LUS authority now.

Even when we in government and parliament grant greater powers, we must be convinced that it will be correct so that they can be handled in a wise manner.

Let me mention the last difficult matter. When we work with advanced crime, we also find insiders in municipalities, regions and authorities. It is a challenge for all of us.

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Lars Isacsson (S)

Madam Speaker! I thank the Minister for the opportunity to have this debate. This is interesting, and I would have gladly had more contributions, because I want to talk about the municipalities' opportunities.

I think it is good that the Minister mentions that the median municipality has 16,000 inhabitants. Half of Sweden's municipalities therefore have fewer. Thus, the problems with the supply of competence and the insiders' improper influence become even greater.

It has become clear in the debate that the government and we Social Democrats take the issue seriously – perhaps there is a difference in what we are prepared to do. There must be more opportunities to break secrecy, says the Minister. I agree with that. I sit on the Committee on Justice. During the mandate period, we have made many decisions here in the chamber regarding secret coercive measures that affect the privacy of private individuals. But not as many decisions have been made regarding corporate secrecy. There is more to be done there.

The government refers to instructions and the regions' responsibilities. That is good, but we as legislators cannot be satisfied with that. When our legislation fails to stop serious economic crime in health and social care, it is not just a legal problem but also a political betrayal.

The Social Democrats want the authorities to have the right to revoke permits in cases of serious economic crime. We want to introduce Swedish anti-mafia legislation with a coordinated agency responsibility against organized crime in the welfare system. It must be very difficult, and not easy, to profit from the welfare system.

Madam Speaker! As long as it is easier to obtain a permit to run a health center with links to serious organized crime than to obtain a building permit in a small Swedish municipality, we have a systemic failure, and I think that is unreasonable.

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Statsrådet Acko Ankarberg Johansson (KD)

Madam Speaker! I would like to thank the member again – the member may return so that we can continue the discussion. We have, in broad terms, a very large consensus.

It should not be possible to run a health center if one is a criminal. But that depends on the agreement the region enters into. There are already provisions in the laws regarding choice systems so that we can exclude those who are not suitable. But one must go deep and examine the law, because the Local Government Act gives you rights. You do not need to look at a new mafia law, because the Local Government Act gives you far-reaching powers. Test them, use them, before we impose new laws.

I really wish that municipalities and regions sometimes dared to go to court. I understand that it is a cost. But it is not dangerous if we were to lose, because then we know what the law is sufficient for. We get a precedent and know what we need to adjust.

Now that we have laws that give a region far-reaching opportunities to control what is handed over to someone else to perform so that the public has the required oversight, we must use them; it has indeed proven necessary. I know that the private operators one encounters in organizations such as Vårdföretagarna and similar ones welcome that the opportunities provided by the Local Government Act and the agreements are used. They are not against this – they also want to ensure that unserious and criminal actors disappear. We therefore have nothing to lose by using the tools that the law contains.

We are still working on several legislative changes. It concerns investigations that have recently arrived, and we will also in the near future appoint additional investigations to continue. The area is so large. We have added funds of a significant extent: 30 million to Ivo last year and 28 million this year, persistently every year. We add new laws and powers. And all the time, the criminals are almost better than we are. It is therefore a heavy task to keep up.

But use the laws, dare to go to court, dare to test the very limit! That is the only way to counter this. Just as the member said, it should be difficult to face the public if you are a criminal. We shall make it truly difficult so that we stop them.

The interpellation debate was hereby concluded.

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